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Assassination Records Review Board
Final Determination Notification

AGENCY : HSCA
RECORD NUMBER : 180-10068-10321
RECORD SERIES : STAFF PAYROLL RECORDS
AGENCY FILE NUMBER :

December 8, 1995
Status of Document: Postponed in Part

Number of releases of previously postponed information: 5

Reason for Board Action: The Review Board's decision was premised on several factors
including: (a) the significant historical interest in the document in question, (b) the
absence of evidence that the release of the information would cause harm to the United
States or to any individual.

Number of Postponements: 4

Postponements: All the postponements in this document represent Social Security numbers.

Reason for Board Action: The text is redacted because the public disclosure of the redaction could
reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of
privacy would be so substantial that it outweighs the public interest.

Substitute Language: SSN

Date of Next Review: 2017

Board Review Completed: 10/24/95

ennedy dssassination
ecords Collection Act of

992 [44 USC 2107 Note).
ased- Nw 86326 Date:

| NW 88326
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JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
“AGENCY INFORMATION

HSCA

Date:08/20/93
Page:1

AGENCY :
RECORD NUMBER : 180-10068-10321
RECORDS SERIES :
STAFF PAYROLL RECORD
AGENCY FILE NUMBER :
DOCUMENT INFORMATION
ORIGINATOR : HSCA
FROM :
TO ;:
TITLE :
DATE : 08/18/77
PAGES : 5
_ SUBJECTS :
HSCA, ADMINISTRATION
DOCUMENT TYPE : PRINTED FORM
CLASSIFICATION : U
| RESTRICTIONS : 3
: CURRENT STATUS : P
| DATE OF LAST REVIEW : 07/07/93
OPENING CRITERIA :
| COMMENTS :
Box #:1.
[R] - ITEM IS RESTRICTED
| NW 88326

PAYROLL AUTHORIZATION FORM : . - ee:

. (Please: Use Typewriter: : U.S. HOUSE OF ‘REPRESENTATIVES _ > (Any erasures, corrections, or. changes ~

; . ; on this form must be initialed by the .
i - or Ballpoint Pen) — - Washington, D. Cc. 20515 - authorizing official.) |

~

wate UBER

_ To the Clerk of the House of Representatives:

| hereby authorize the following payroll action:

Fated toenail FP at.

Employee Name (First-Middle-Last) 7 E Z oe no ~ Effective Date Be a

Cliver J. Champlea _ ___ 8/31/78 34
Employee Social Security Number. oo, Type of Action _

DO Appointment :

086-46-9505 _
Employing Office or Committee/Subcommittee - Z ‘Cl Title Change

Termination (At close of business on effective date)

DO Salary Adjustment

_ . . D Leave without pay (Beginning with effective date above and ending |.
Agcocsiratidons ; close of business )

Specify Date

(If. type of action is an Appointment, Salary.Adjustment, or Title Change, complete appropriate. information below.) -

oo , Position Title

Gross Annual Salary*

~. * If emoloyee i is-a civil service annuitant (includes U.S:: House of Representatives), tthe | gross annual salary shown should include the-annuity received by the employee
plus the salary received from the employing office.
(If Committee Employee, complete appropriate item below.) c
. ’ \
1. O Standing Committee: Staff—O Clerical or 0) Professional. S \
\
2. CE Special (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res:_ 958 of £5ENCongress 5
3. C1 Joint Committee.
(If Employee of an Officer of the House, complete item below.) eo See
Position Number_____ ____-_.___.|f applicable, Level. Step. :
| certify that this authorization is not in violation of 5 U.S.C. 3110(b); prohibiting the. employment of ~~:
relatives. 4
Date.___September 24 20 (1948. a
cb : : (Signature of Aothorizing Official) : ‘
~~~ ------~ ~~ 2---- n-ne --------a---.---- DOUES_STOKES, CHAIRMAN :
(if appropriate,. signature of Subcommittee Chairman or Ranking Minority Member) (Type or print name of Authorizing Official) 3
ee (Type or print name and fitle of above official)». === =S=SSC<“~*“‘“‘~™S™*:*:”SS!S!!”!”!”!”!” Gite Member, District ond Sore) :

All appointments and: salary adjustments for employees under the House Classification. Act and for:Committee‘em- . ~

- ployees, except those of the Committee on. Appropriations, the. Committee-.on-the Budget, and the Joint Committees; must . \
be approved by the Committee on House Administration. - . ; . \

APPROVED: |

Chairman, Committee on House Administration

Office of Finance use only:

Office Code . . . ; -

: . (Revised: August 1, 1977) :
Copy for Initiating. Office or Committee: Ba

eee ee Hae a aa - are west

Tw 88326 : FO —
| Docld:32243287 Page 3 : vo ;


| PAYROLL AUTHORIZATION FORM - . .
.. (Please Use Typewriter “- U:S. HOUSE OF ‘REPRESENTATIVES . © (Any erasures, corrections,-or changes

or Ballpoint'Pen) Washington, D.C.20515 on this form must be initiated by the |<

authorizing official.)

To the Clerk of the House of Representatives:

! thereby authorize the following payroll action:

Employee Name (First-Middle-Last) a a Ce | ~ Effective Date
Gliver ca Champion , Harch 1, L978

Employee Social Security Number - oo. Type of Action
88 6-46—9 505 ; O Appointment

. _. . ___|30% Salary Adjustment
Employing Office or Committee/Subcommittee = === — | O Title Change

OO Termination (Ai close of business on effective date)

C Leave without pay (Beginning with effective date above and ending

close of business... = )
Specify Date

Position Title ~

Cierical Assistant | $22,868 |

- ¥ If employee js_a civil service annuitant (includes U.S. House. of Representatives), the gross annual salary. shown should inclide the annuity received by the employee
plus the salary received from the employing office.

Gross Annual Salary*

(If Committee Employee, complete appropriate item below.)

1. O Standing Committee: Staff—O] Clerical or Professional...

2. 1eSpecial (Investigative staff of Standing Committee) or Select Committee: Authority—H. Res.2 55: of S&:t!¢ongress.
3. D1 Joint Committee.

(If Employee of an Officer of the. House, complete item below.) -

Position Number. lf applicable, Level. Step.

relatives.

All appointments: and salary adjustments -for employees under. the House Classification Act-and. for Committee em-
. ployees, except those of the: Committee on Appropriations, the Committee on the Budget; and the Joint Committees, must
be approved by the Committee on House Administration.

APPROVED:

Chairman, Committee on House Administration

Office of Finance use only:

Office Code

| NW 88326 SO ree |
| Docld:32243287 Page 4 ; Se

Bek te a daca

_(If type of action is an Appointment; Salary Adjustment,‘or Title-Change, complete appropriate. information below.) - =~ = "~*~

| certify that this authorization is- not in violation of 5 US.C. 311 0(b}, prohibiting the employment of -

vt

acd mo Nd ros 3
Bay ttre Bae One arene bee ne eer ce ae

Ln Ne


relatives. :

Date December i 19°? :

ee a we ea a ae ee ee ee f ——— = 4

Uf appropriate, ‘signature of Subcommittee Chairman. ‘or Ranking Minority Member) . a ” : (Type or print name of Authorizing Official) - A

fo ee, boat onan, wana _ 4
: ab . (Type or print name and title of above official) . a (Title-1f Member, District and State) ; 3
All appointments and salary adjustments.for employees. under the House Classification Act-and for Committee em- 4

ployees, except those of the Committee .on:Appropriations, the Committee on the Budget, and the: Joint Committees, must ad

be approved by the Committee on House Administration. Lo id
APPROVED:.___--- = _ 4

Chairman, Committee on House Administration : 1

PAYROLL. AUTHORIZATION FORM

_ (Please Use Typewriter U.S. HOUSE OF REPRESENTATIVES Any erasures, corrections: or changes

. - : n this form must be initialed by the . 7 :
or Ballpoint Pen) -Washington, D.C. 20515 authorizing official.) ooo

To the Clerk of the House of Representatives:

re ae, eogtares
fMunete el e A a  a

Benita Es TE et! da dae ala eta oe

| hereby authorize the following payroll action:

Employee Name (First-Middle-Last) == oe ___Effective Date | | oo
iver Jo Champion | __Bacesber 3, 1977
. | Type of Action

0 Appointment

arnt

Salary Adjustment . ; ;
O Title Change _ : re
0 Termination (At close of business on effective date)

- ; : Bs oy WARY Ge ; 0 Leave without pay (Beginning with effective date above and ending

close of business
: Specify Date

ESN bate Mie ke oe at

(If type. of action is an Appointment, Salary. Adjustment, -or Title Change, complete appropriate information below.)
ae Position Title . Gross Annual Salary *
Clerical Assistant $37,000 |
aE employee i is.a civil service annuitant (includes U.S. House: of Representatives), the gross annual salary shown should include the annuity-received by the employee 3
plus the salary received from the employing office. a
(If Committee Employee, complete appropriate item below.)
1.0 Standing Committee: Staff—O Clerical or 0) Professional. :
2. :&: Special (Investigative staff of Standing Committee} or Select Committee: Authority—H. res. 285 of 25 Ee congress
3. 0 Joint Committee. 4

(If Employee of an Officer of the House, complete item below.)

Position Number If applicable, Level

| certify. that this authorization is not in violation of 5 USC. 8M 0b, Profibiting § the employment of - 4

Office of Finance use only:

q

3

Office Code . ‘
. 3

4

4

Vi (Revised: August 1, 1977}

NW 88326 foe

po
Dochd:37243267 Page 5 ;

a PAYROLL ‘AUTHORIZATION | FORM

~ or Ballpoint Pen). ° ‘authorizing official.) ~

To the Clerk. of the House of Representatives:..°- 0-88) Soe cece ee

~ Uhereby authorize the following payroll action: "0% | va

a __Employee t Name (First-Middle-Last) « eee Gone “2 Lo a Effective Date iw oe
Oliver J. Champion - B/18/77

"86-46-9506

[x] Appointment

—_—

; Employing Office or Committee... _—~(| L Sclory. Adjustment © ss

Assassinations Pe, oo () Termination (At close of business on effective date)

.~{IF:typeof-action is an. Appointment.or. Salary Adjustment,.complete: the following information:)<° ~

Position Title - a _ = 7 . a . = = 7p = “Gross Annual Salary :

“Clerical Assistant _ . $9,500

(If Committee Employee, completé-appropriate item: below.) . 5 one oe

| ce 1 Standing Committee: Staff-[] Clerical or [} Professional. 9-0 -- vgn ©
22: (8) Special or Select Committee: Authority~H. Res. 465 _of B5%h Congress:

3. [_] Joint Committee.

(If Employee of an Officer of the House; complete item below.) =: <..-.> t.2 0 ees!

If applicable, Level_-

i , Position Number

relatives.

Date Auaqust 22 19 77

(Type or print name of Kothvizing ‘Official

LOUIS STORES » CHATRY A

be approved by the Committee on House Administration.

’ Chairman, Committee on House “Administration

APPROVED:

Office of Finance use only:

Office Code

ne —. - a an —— a -- ee me eee ee or . na

NW 88326 | FO a

Docld:32243287 Page 6 : ee ;

+ (Please Use Typewriter ae °U. S. HOUSE oF REPRESENTATIVES. © (Any erasures, Corrections, or changes: -. 3:
- Washington, D.C..20515* "-.. on this.form: must. be- initialed by. the. «:

~Emplayee Social Security Number SS Pp Type of Action

Bike, hPa hs tg ba eek al ng athe a Bae
woh ieale lt a arnt hanes nae lea ethionine

“A -certify. that this - authorization tis. notin’ -violation:-of 5. U.S.C. -3110(b),.. prohibiting the employment of

wa BL ee a a ee te AH a. anne Bee et on rn es ee ee .

All appointments and salary adjustments for*employees ‘under: the: House. Classification Act and for: Committee em:
» ployees,.except. those. of the Committee on Appropriations; the. Committee~on. the’ > Budget, and ‘the Joint: Committees, must’ ~'-°

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4
| NW 88326

MEMORANDUM

TO: ALL STAFF
RE: Payroll Certification

The Regulations and Accounting Procedures for Allowances « and
Expenses. of Committees, Members and I emproyees of the U5. House of .
Representatives require that, among other things, tne Committee's
monthly payroll ‘certification include the relationship, if any, of
each emp) oyee to any current Member of Congress. This certification

is signed monthly by our Chairman.

The following are the relationships to be included in the -
certification:

father ; _ nephew ~ brother-in-law
mother niece. . sister-in-law
son . . husband stepfather
daughter Wwife- ~ §tepmother
brother . ~ Fatner-in-law ~stepbrother
sister mother-in-law . stepsister
uncle son-in-law half-brother

aunt . . daughter-in-law half-sister
first cousin a

Piease complete the appropriate portion below, sign and date

this form, which will then become a part of your permanent personnel
file. If this status changes, you must noti ify the Committee's Budget.

Office immediately of the change.

be 1 am not related to any current (95th Congress) Member of Congress

f./ I am related to a current (95th Congress) Member of Congress.

(Please specify. )

| Docid:32243287 Page fT

